Project Summary: In humans, multiple early exposures to procedures requiring anesthesia is a significant risk factor for development of learning disabilities and disorders of attention and longer, but not shorter, durations of anesthesia during a single exposure are also associated with adverse outcomes. While preclinical studies show a dose?response relationship between the duration of general anesthesia and adverse cellular and functional outcomes the underlying molecular mechanisms remain to be fully elucidated. Evidence indicates that impaired hippocampal spinogenesis and synaptogenesis may be involved in the mechanisms by which early anesthetic exposure produces long-term cognitive impairment, and that synaptic scaffolding protein PSD- 95 PDZ domain-mediated protein-protein interactions and synaptic activities are involved. Our previous studies have demonstrated that PDZ domain-mediated protein interactions are disrupted by clinically relevant concentrations of inhaled anesthetics. Recently, we showed that exposing postnatal day (PND) 7 mice to isoflurane inhibits dendritic spine development, alters synaptic plasticity, and impairs learning and memory function in relation to the anesthetic disruption of PSD-95 PDZ binding domains. Our results showed that the disruption of PDZ interactions and PDZ domain-mediated synaptic function may play important roles in the pathogenesis of early anesthetic exposure-produced long-term cognitive impairment. We hypothesize that early exposure to inhalational anesthesia alters neural development by disrupting PDZ-domain mediated interactions causing uncoupling of PSD-95-NMDAR and associated synaptic complexes resulting in inhibition of several prominent downstream signaling pathways critical to dendritic spine, synapse, and arbor development, thereby producing long-term neurocognitive dysfunction. To address this hypothesis, our aims will identify the signaling pathways and mechanisms that link anesthesia induced uncoupling of PSD-95 PDZ- NMDAR-nNOS synaptic complex to changes in spine and synapse maturation critical to neural circuit formation (Aim 1); we will validate, in vivo, key downstream signaling components effected by disruption of the synaptic complex, PSD-95-NMDAR-nNOS, and determine if restoring them can sufficiently prevent the deleterious effects of anesthesia on dendritic spine and synaptic development, LTP, and memory (Aim 2); assess whether PDZ domain disruption delays the NR2B to NR2A developmental switch, affects growing dendrites and the spatial and temporal expression patterns of critical plasticity related proteins in glutamatergic synapses, and determine if arbor disturbances can be prevented using over-expression and knock-down approaches (Aim 3). The proposed studies will identify the signaling pathways and mechanisms linking anesthesia induced uncoupling of PSD-95 PDZ-NMDAR and associated synaptic complexes to changes in dendritic spine, synapse, and arbor development that lead to long-term cognitive impairment.